¹Hamzei P., ¹Fricke J., ¹Neugebauer A., ²Michel O., 1Rüssmann W.

¹Klinik und Poliklinik für Schielbehandlung und Neuroophthalmologie, ²Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde der Universität zu Köln

Objective: The aim of this study was to analyze the influence of the preoperative horizontal deviation (PRHD) and of the preoperative motility on the horizontal deviation (POHD), ocular alignment and diplopia after decompression.
Methods: In a retrospective consecutive case series study we reviewed charts of 61 patients with Graves´ ophthalmopathy who underwent bilateral endonasal orbital decompression between 1990 and 1999. In 28 patients decompression was combined with bimedial rectus muscle recession (BMR) in the same session (group 2), in 33 it was not (group 1).
Results: In group 1 esotropia was induced or a preexisting esotropia worsened after decompression. There was a linear correlation between PRHD and POHD (p < 0,001). The additional consideration of the preoperative aband adduction did not improve POHD estimates. To reduce the POHD BMR (5-9 mm of each medial rectus) was performed in group 2 . There was a linear correlation between the amount of BMR and PRHD (p < 0,001). There was no linear correlation between the preoperative ab- and adduction and the amount of BMR. By combined surgery the number of squint operations required after decompression could be reduced significantly as compared to group 1. A decline in POHD could be achieved by combined surgery but there was still a linear correlation between PRHD and POHD (p < 0,001).
Conclusion: POHD could be predicted from PRHD in group 1. Preoperative excursions did not improve POHD estimates. By combined surgery POHD and the number of required squint surgeries after decompression can be reduced significantly.

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